Electronic Prescribing at the Point of Care: A Time-Motion Study in the Primary Care Setting

Objective To evaluate the impact of an ambulatory computerized provider order entry (CPOE ) system on the time efficiency of prescribers. Two primary aims were to compare prescribing time between (1) handwritten and electronic (e-) prescriptions and (2) e-prescriptions using differing hardware configurations. Data Sources/Study Setting Primary data on prescribers/staff were collected (2005-2007) at three primary care clinics in a community based, multispecialty health system. Study Design This was a quasi-experimental, direct observation, time-motion study conducted in two phases. In phase 1 (n=69 subjects), each site used a unique combination of CPOE software/hardware (paper-based, desktops in prescriber offices or hallway workstations, or laptops). In phase 2 (n=77), all sites used CPOE software on desktops in examination rooms (at point of care). Data Collection Methods Data were collected using TimerPro software on a Palm device. Principal Findings Average time to e-prescribe using CPOE in the examination room was 69 seconds/prescription-event (new/renewed combined)-25 seconds longer than to handwrite (99.5 percent confidence interval [CI] 12.38), and 24 seconds longer than to e-prescribe at offices/workstations (99.5 percent CI 8.39). Each calculates to 20 seconds longer per patient. Conclusions E-prescribing takes longer than handwriting. E-prescribing at the point of care takes longer than e-prescribing in offices/workstations. Improvements in safety and quality may be worth the investment of time.